title: A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study.
abstract: BACKGROUND
  Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury.
  
  
  METHODS
  We undertook a longitudinal cohort study of adult patients with traumatic spinal cord injury, with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008. A clinical prediction rule based on age and neurological variables was derived from the international standards for neurological classification of spinal cord injury with a multivariate logistic regression model. Primary outcome measure 1 year after injury was independent indoor walking based on the Spinal Cord Independence Measure. Model performances were quantified with respect to discrimination (area under receiver-operating-characteristics curve [AUC]). Temporal validation was done in a second group of patients from July, 2008, to December, 2009.
  
  
  RESULTS
  Of 1442 patients with spinal cord injury, 492 had available outcome measures. A combination of age (<65 vs ≥65 years), motor scores of the quadriceps femoris (L3), gastrocsoleus (S1) muscles, and light touch sensation of dermatomes L3 and S1 showed excellent discrimination in distinguishing independent walkers from dependent walkers and non-walkers (AUC 0·956, 95% CI 0·936-0·976, p<0·0001). Temporal validation in 99 patients confirmed excellent discriminating ability of the prediction rule (AUC 0·967, 0·939-0·995, p<0·0001).
  
  
  CONCLUSIONS
  Our prediction rule, including age and four neurological tests, can give an early prognosis of an individual's ability to walk after traumatic spinal cord injury, which can be used to set rehabilitation goals and might improve the ability to stratify patients in interventional trials.
  
  
  BACKGROUND
  Internationale Stiftung für Forschung in Paraplegie.
authors.affiliation: Spine Unit, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. jvanmiddendorp@gmail.com
authors.forename: Joost J
authors.initials: JJ
authors.lastname: van Middendorp
authors.forename: Allard J F
authors.initials: AJ
authors.lastname: Hosman
authors.forename: A Rogier T
authors.initials: AR
authors.lastname: Donders
authors.forename: Martin H
authors.initials: MH
authors.lastname: Pouw
authors.forename: John F
authors.initials: JF
authors.lastname: Ditunno
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van de Meent
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination / Q000379:methods*; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016138:Walking / Q000502:physiology*; D055815:Young Adult